Provider Demographics
NPI:1891275145
Name:SMITH, CHAD DARRON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:DARRON
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18904 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2964
Mailing Address - Country:US
Mailing Address - Phone:352-562-3572
Mailing Address - Fax:
Practice Address - Street 1:4500 BISCAYNE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3236
Practice Address - Country:US
Practice Address - Phone:786-361-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9296171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily